Peripheral arterial disease: exclusion criteria for exercise training?

Abstract

Background: Peripheral arterial disease (PAD) is strongly associated with increased cardiovascular risk and limitswalking ability, further contributing to physical inactivity, cardiopulmonary and peripheral muscledeconditioning, worsened cardiovascular risk factor profile further compromising prognosis of ischemiccardiomiopathy.

Objective: Establish prevalence of vascular claudication in a hospital-based cardiac rehabilitation (CR) setting, andassess its influence on cardiac rehabilitation outcomes, including functional, psychosocial and quality of lifeaspects.

Methods and Subjects: Longitudinal interventional study of patients who completed a two-month phase II CRprogram, recruited between October 2008 and March 2010. Data on sociodemographic, clinical, laboratorial,echocardiographic and functional capacity was collected from clinical files. Quality of life and walking limitationwere assessed by Short-Form 36 (SF-36) version 2 and the Walking Impairment Questionnaire (WIQ), respectively.The authors summarized walking ability using a mean value of the three components of the WIQ, and furthercategorized patients in two groups: claudicating (<80%) and non-claudicating (≥80%).

Results: A total of 126 patients were analyzed, including 47 (40,8%) with clinical claudication. Except for gender,with higher proportion of claudication in males (p<0,05), there were no difference between groups in age, levelof education or professional status. Prevalence of hypertension, diabetes, tobacco consumption, overweight andabdominal obesity was higher in the claudicating group. Walking impairment was associated with higher levelsof anxiety, depressive symptoms, lower functional capacity and functional impairment in both physical andmental dimensions of health-related quality of life, both at program entry and completion. Both groups showedsimilar improvements in anthropometric, functional and quality of life measures.

Conclusions: An individually tailored CRP allows for significant gains in functional capacity and health-relatedquality of life, even in those severely impaired by their peripheral arteriopathy. Adjustments in both intensity andvolume of exercise training sessions will allow for significant improvements and compliance withrecommendations for secondary prevention in coronary heart disease in this subset of the coronary heart diseasepatients.

Keywords: Peripheral Arterial Disease; Cardiac Rehabilitation.